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State-of-the-Art Treatments for Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy

Atrial fibrillation (AF) and hypertrophic cardiomyopathy (HCM) are two very common clinical entities, which often occur simultaneously, giving a hard time to both patients and cardiologists. Myocyte hypertrophy, myocyte disarray and interstitial fibrosis in the left atrium (LA) predisposes to atrial...

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Autores principales: Penela, Diego, Sorgente, Antonio, Cappato, Riccardo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8303743/
https://www.ncbi.nlm.nih.gov/pubmed/34300191
http://dx.doi.org/10.3390/jcm10143025
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author Penela, Diego
Sorgente, Antonio
Cappato, Riccardo
author_facet Penela, Diego
Sorgente, Antonio
Cappato, Riccardo
author_sort Penela, Diego
collection PubMed
description Atrial fibrillation (AF) and hypertrophic cardiomyopathy (HCM) are two very common clinical entities, which often occur simultaneously, giving a hard time to both patients and cardiologists. Myocyte hypertrophy, myocyte disarray and interstitial fibrosis in the left atrium (LA) predisposes to atrial arrhythmias due to modifications of the substrate that promote re-entry. AF is usually poorly tolerated due to the shortening of the diastolic time with rapid heart rates and the lack of the atrial contribution to the diastolic filling in patients who often have a previous diastolic dysfunction. AF onset frequently results in exercise intolerance and recurrent heart failure admissions and also has prognostic implications. Early maintenance of sinus rhythm appears as a worthy approach in these patients, especially when started early in the course of the disease. However, treatment with antiarrhythmic (AA) agents in HCM patients is less effective than in patients without the disease, and concerns regarding safety frequently limit the long-term adherence. Catheter ablation has limited efficacy in patients with persistent AF but can play an important role in patients with paroxysmal AF, emphasizing the importance of an accurate patient selection. The aim of this review is to provide an overview of the pathophysiology of combined HCM and AF and the principal pharmacological and non-pharmacological treatments recommended in this complex clinical scenario.
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spelling pubmed-83037432021-07-25 State-of-the-Art Treatments for Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy Penela, Diego Sorgente, Antonio Cappato, Riccardo J Clin Med Brief Report Atrial fibrillation (AF) and hypertrophic cardiomyopathy (HCM) are two very common clinical entities, which often occur simultaneously, giving a hard time to both patients and cardiologists. Myocyte hypertrophy, myocyte disarray and interstitial fibrosis in the left atrium (LA) predisposes to atrial arrhythmias due to modifications of the substrate that promote re-entry. AF is usually poorly tolerated due to the shortening of the diastolic time with rapid heart rates and the lack of the atrial contribution to the diastolic filling in patients who often have a previous diastolic dysfunction. AF onset frequently results in exercise intolerance and recurrent heart failure admissions and also has prognostic implications. Early maintenance of sinus rhythm appears as a worthy approach in these patients, especially when started early in the course of the disease. However, treatment with antiarrhythmic (AA) agents in HCM patients is less effective than in patients without the disease, and concerns regarding safety frequently limit the long-term adherence. Catheter ablation has limited efficacy in patients with persistent AF but can play an important role in patients with paroxysmal AF, emphasizing the importance of an accurate patient selection. The aim of this review is to provide an overview of the pathophysiology of combined HCM and AF and the principal pharmacological and non-pharmacological treatments recommended in this complex clinical scenario. MDPI 2021-07-07 /pmc/articles/PMC8303743/ /pubmed/34300191 http://dx.doi.org/10.3390/jcm10143025 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Brief Report
Penela, Diego
Sorgente, Antonio
Cappato, Riccardo
State-of-the-Art Treatments for Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy
title State-of-the-Art Treatments for Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy
title_full State-of-the-Art Treatments for Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy
title_fullStr State-of-the-Art Treatments for Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy
title_full_unstemmed State-of-the-Art Treatments for Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy
title_short State-of-the-Art Treatments for Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy
title_sort state-of-the-art treatments for atrial fibrillation in patients with hypertrophic cardiomyopathy
topic Brief Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8303743/
https://www.ncbi.nlm.nih.gov/pubmed/34300191
http://dx.doi.org/10.3390/jcm10143025
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